Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00175
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2020
Parcel: 1 S136DC03300
Jurisdiction: Tigard
Site address: 11734 SW 72ND AVE
Project: The 72nd Avenue Salon Subdivision: 72ND AVE APARTMENTS Lot:
Project Description: Interior plumbing for a new salon in the retail space of the 72nd Avenue apartment building:Adding(1)2"floor
drain, (3)sinks,and(1)water closet; Installing(1)primer and(1)water heater.
Contractor: CROMWELL PLUMBING Owner: 72ND AVENUE PROPERTY LLC
25599 SW 95TH AVE STE B BY RICHARD CASSINELLI
WILSONVILLE, OR 97070 4804 NW BETHANY BLVD#I-2
PORTLAND, OR 97229
PHONE: 971-224-5304 PHONE:
FAX: 503-266-4792
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 04/29/2020 $25.02
Specifics: 1 ea Primer 04/29/2020 $12.51
3 ea Sink 04/29/2020 $75.06
Type of Use: COM 1 ea Water Closet 04/29/2020 $25.02
Class of Work: ALT ea Water Heater 04/29/2020 $37.52
Type of Const: 1 12%State Surcharge- 04/29/2020 $21.02
Occupancy Grp: Plumbing
Stories:
Total $196.15
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions
�sttooOOUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:d%S Permittee Signature: L
�1-G��rIYCJ? .i Mn
Call 603.639.4176 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
}
Plumbing Permit Application
Building Fixtures REC, IV " . ,r Toe (0.1 11
t' City of Tigard a eri
tc' o- l�Date,0y. '�/A- t •.417' Perna
Ne.: 9/ 2OX"'e ) ,7J
r 13125 SW Hall Blvd.,Tigard,OR 97223 APR 6 20 plan Review i/` -elf
>i ('hone 503.718.2434 Fax 503.598,1960 Uatr16 Nf� Other Permit Na.:/�-ll �_ ry��
TIt;A112i7 lnspectton incL : 543.634.4175 GITY OF rtGA rae Ready/By: f / !rts: 0 See Pwagte2 or tWtJ
Internet. www-Tigard-or.gov } tied/Medmd' 9X ) j Supplemental Information
TYPE of WORK 3U1t i71�lG D1Ut i' l I RE* SCfEDIILE
0 New construction 0 Demolition Forspeciul infomtn{ian use checklist.
❑Addition/aiterationfreplacelnent 0Other: New Description r__.- { .1 Total
1-2-family dwellings(includes.}OQ R.for each utility connection)
CATEGORY OF CONSTRUp'ION SFR(1)bath 312.70
❑1-and 2-family dwelling commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other Fire sprinkler( sq.ft) Page 2
OR SITE INFORMATION AND LOCATION Site utilities:
Job site address. I
_„I r .f 72"- Cjt Catch basin or area drain - 1$.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 91(,�,g, { _',_% _ Footing drain(no.linear ft,: ) Page 2
Suite/bldg./apt.no.: Project name: )I ax
ytt 7 Manufactured home utilities 50.03
Cross street/directions to job site: a I4\/v Manholes 18.76
OM - : -T-' rit.4-,r74 ,, 5,=,,, _"' c r# ; Rain drain connector 18.76
iiAi CW it l l r j Sanitary sewer(no.linear ft.:_,,,_) Page?
-"'- Storm sewer(no.linear ft.: ) Page 2
--- Water service(no,linear ft_ i Page 2
Subdivision: { Lot no.: Fixture or item:
Tax map/parcel no.: 3/•�F' t�L.)'Q ._.._.__
Backflnw preve»rer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
pivrvi4t„4'1 'rib( Att;-LJ 'j Dishwasher 25.02 _
i _� Drinking fountain 25.02
Ejectotstsurim 25.02
a PROPERTY OWNER f ❑ TENANT Expansion tank 12.51
r Fixture/sewer cap 25.02
Name: 1 M v. t7,to
7'n.#'i {IC Floor drain/floor sink/hub i 25.02 `;to a
Address: Ill`(0 S,t Q1"J 92 fr"Vt
Garbage disposal 25.02
City/State/ZIP: 11(Ad O ,(. "i r?%7- Hose bib 25.02
Phone:(`{/?, ) 5 / - 521-j eit.�i Fax:( ) Ice maker 12-51 1
i
0 APPLICANT (24.4e0.04-11, 0 CONTACT PERSON Interceptor/grease trap . - 25.02
Business name: Medical gas(value:5 ) Page 2
Primer 1 12.51 13...77
Contact name:
Roof drain(commercial) 12.51
} Address: SinktbasiWlavatory �_-_ '1. 25.02 ?s„c^fr
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tubfshowerlshower pan 12.51
E-mail: Urinal 25.02
---- Water closet i 23.02 t,'. .,+._:
CONTRACTOR
i -�-- --- Water heater 37.52
Business name: C((40,,1t (I ',ivvii fry Water piping/DWV 56.29
Address: � r;P 4yt't ( Ufu Other. 25.02 C
CitylStatelZiP: (i '!'dU4 l f{t94 ''il ' ¢L'' C.% Subtotal 11:-.i
0
Phone:( i:i ) .7<;-i - b; ,;1`3 Fax:( ) Minimum permit fee: $it e)
Plumbing Lie no.: ' plan review (25r/o of permit fee) 1
GCB LAC.: Lj �(�. ( t" )a� 1�• _ State surcharge ofpermittce) ,�^'T7/,(91
Authorized signature: �"".i 7ltll�
ft. TOTAL PERMIT FEE n ` , ;. _
i.
Print name' �J r r I.^ Date-`!/1 .7,„f x.x I This permit applientipa expires if a permit is not abtaiaed within 130 rg Yj4,s 0
lJ ft1Pi`-f I{C fat 'i`�f !'A _I alter tt was b¢en accepted as eoatlitete 7 `
''Fee methodology set by Id-County Building Industry Service Board.
t\naildingWermitsVIASU-PaYmnApp.dc teal/09 .104616T(101021COM/WEa) ZFC1
a J%V"1 / n
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. : Fee(ea) Total Square Footage Permit Fee:
Footing drain- I" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 1.00' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&RamDrai
n in-let 100' 6254aluation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 1 L'0' 37 52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
eacor
Other Inspections or Fees , Qty. Fee(en) Total and hnc uatd ng$i$0,000.00. fraction
won thereof,to
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge—2 hours) each additional$100.00 or fraction thereof to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge—1/2 hour) each additional$100.00 or fraction thereof
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Revie'c for Plumbing Installations
Fixture Type for nepifleCr Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" l Submit 2 sets of plans with any of the above.
-3
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related pe_,. 4r,4v i u. H/2( h) 4-7
Ice Mach./Reftig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station TX^. 5i14 °a " 1614at4 OW $laN%S, 1 f ft(%} I
Shower -Gang 1 i404s-4( Ls/r't.r. 1 (/ e4 `i M( I P4,M4t
-Stall
Sink/Lav -Non-food related 3 /l;r",}#:P
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 1 RIO fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures. 3
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